Virological responses during treatment for recent hepatitis C virus: potential benefit for ribavirin use in HCV/HIV co-infection.

A rise in the incidence of hepatitis C virus (HCV) infection among men who have sex with men (MSM) has been reported [1-6]. In HIV negative individuals with recent HCV, sustained virological response (SVR) ranges from 57-88% with pegylated interferon (PEG-IFN) mono-therapy (12-24 weeks), [7-14] with no evidence of additional benefit for ribavirin (RBV). In those with HIV/HCV, treatment recommendations are less clear [15]. In chronic HCV, PEG-IFN/RBV responses are lower in HIV positive patients (SVR of 27-40% vs. 54-56%) [16-20]. Thus, clinicians use more conservative regimens (e.g. PEG/RBV) to treat recent HCV in HIV positive individuals. It is unclear whether ribavirin provides additional benefit in treatment for recent HCV in those with HIV/HCV. Although data from two small studies suggest that PEG-IFN for the treatment of acute HCV in HCV/HIV co-infection may be ineffective [21, 22], another study showed no difference in those receiving PEG-IFN with and without RBV [23]. Given increased response rates with direct acting antivirals, a randomized controlled trial comparing PEG-IFN with and without ribavirin during recent HCV is unlikely. Data informing guidelines for treatment of recent HCV within this population are required. The Australian Trial in Acute Hepatitis C (ATAHC) investigated treatment for recent HCV (HIV positive and negative). This study evaluated virological decline (and impact of ribavirin) during treatment for recent HCV, based on a non-randomised comparison of HCV infected individuals receiving PEG-IFN monotherapy and HCV/HIV infected individuals receiving therapy with PEG-IFN/ribavirin. Predictors of rapid virological response (RVR) were also evaluated.